Healthcare Provider Details

I. General information

NPI: 1679549943
Provider Name (Legal Business Name): ANN M WELTY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12634 OLIVE BLVD
SAINT LOUIS MO
63141-6337
US

IV. Provider business mailing address

660 S EUCLID AVE C B 8054
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-8685
  • Fax: 314-996-8710
Mailing address:
  • Phone: 314-996-8685
  • Fax: 314-996-8710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number127076
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: